-LRB- CNN -RRB- -- High-flying acrobats . Death-defying leaps . Bright lights and performance tents filled with adoring fans . It 's the stuff of which dreams are made . After all , who does n't want to run away with the circus ?

But for Joe Putignano , it was n't as simple as running away -- it took a lifetime of dedication and a battle against addiction to get where he is today : dangling from the 40-foot-high catwalk above the Cirque du Soleil big top .

The house lights are off , and one lone spotlight shines upon Joe 's reflective mirror-ball suit .

He is tethered at the waist , head tilted back , arms reaching behind him to grab his foot , which is quickly flexing up toward his head . He starts to spin -- literally because that 's what his character is supposed to do , and figuratively , because of the searing pain he 's feeling in both shoulders as he contorts into this position .

Though it may seem that Cirque characters are superhuman , they too can get injured . Joe is a real human being with real muscles , bones , connective tissue and joints .

And for Joe , it 's not just high-flying acrobatics that cause him pain .

`` It 's sort of mundane things , '' he says . `` Sleeping hurts a lot , because I 'm rolling over on my shoulder . Just drinking a coffee . Washing my hair hurts a lot . ''

After nearly 1,000 performances of `` Totem '' and a lifetime of gymnastics training , Joe has finally hit a wall .

`` I need to have surgery , '' he says matter-of-factly . `` I really wanted to see if I could continue on , and just kind of manage it , do a lot of physical therapy , and get out of this pain . But we 've done that , and we 're kind of out of options . ''

Cirque du Soleil star : Why I fear pain

Joe has what 's called a superior labral tear from anterior to posterior -- a SLAP tear for short -- in his right shoulder . His biceps tendon is also torn , and he has a third tear in the subscapular area underneath his shoulder blade .

His left shoulder has just the one injury -- another SLAP tear . That one needs to be operated on as well , and soon , before he has permanent damage to the joint .

And surgery has to be done in a way that preserves Joe 's abilities to perform .

`` I suppose there 's always a risk that when they do fix it , that it will destroy my flexibility , '' Joe says . `` I 'm useful in this industry because of my flexibility . ''

Now this contortionist is headed to another arena with bright lights , where all eyes are focused on him : the operating room . Surgery is scary for anybody , but for Joe , it is potentially the most terrifying thing he 's ever encountered .

Joe is a recovering heroin addict . He 's been clean for more than five years , but the thought of anything affecting his sobriety -- particularly opioid painkillers after surgery -- is something he is n't willing to risk .

`` Opiates made me feel like I was the greatest human being possible . Protected , cared for , loved -- all internally , '' he said . `` So I started my path on opiates and abused them , which ultimately lead me to heroin . ''

`` I 'm terrified that if I have an opiate , will it trigger this kind of sleeping demon inside of me ? ''

Joe 's fears are n't unfounded .

`` I recently met a woman who was 10 years sober , and she had breast cancer , '' he said . `` She was given Percocet for the pain , and she ended up relapsing . Why does that have to be our reality ? ''

He 's determined to not let it become his reality , both for his own benefit , and to show other addicts they do n't have to fear a day where they need surgery .

In 2009 , 605,000 Americans who were 13 and older reported abusing heroin in the preceding year , according to the National Institute on Drug Abuse .

That same year , 16 million Americans `` misused prescription pain relievers , tranquilizers , stimulants or sedatives for nonmedical purposes , '' according to that same report .

Most of these nearly 17 million Americans will need surgery someday , and many of them will be prescribed opioid painkillers to combat post-operative pain .

`` We do n't have exact numbers of the percentage of former addicts that are going back for surgery , but this is definitely a growing problem in America , '' said Dr. Boris Spektor , assistant professor of anesthesiology and pain management at Emory University and the person who will be managing Joe 's pain throughout the process .

`` As more and more people are using opioid substances for nonmedical reasons , and using them for medical reasons out of proportion for the dosages that they should be prescribed , it 's something we 're going to see a lot more of . ''

Joe 's specific plan for post-operative pain management has several facets , the first of which is a pre-operative nerve block .

`` It 's a way of giving some numbing medication directly to the nerves that are going down to the shoulder , '' said Spektor , `` and we 'll do that for as long as possible , because with each passing day , the pain is going to get better . ''

There is one problem -- Spektor says nerve blocks are usually inserted while the patient is awake to make sure they 're placed properly .

Typically they would also give the patient a sedative to help with the pain and anxiety of the procedure , but Joe has abused all three of the medications they use for sedation .

So he 'll be fully awake as Spektor pokes around in his shoulder to place the nerve block .

Step two of Joe 's pain-management plan involves a cocktail of medications -- none of them drugs of abuse -- intended to reduce swelling , turn down the nerves ' pain signals and reduce Joe 's stress-response to pain .

Step three involves going to Narcotics Anonymous and Alcoholics Anonymous meetings regularly before and after surgery .

During step four , Joe will see a psychologist the day after surgery and regularly after that to ensure he stays on the right mental path .

And just to add insult to injury , Joe has to go through this intense process twice -- once for each shoulder .

`` In my head , it 's like -- OK , we 're going to go and visit hell , not just once , but twice , '' he said . `` I feel like it 's somewhat of a cosmic joke on me . ''

But will these efforts pay off ? Will the plan work ?

`` I think every patient is unique , '' Spektor says . `` But I think Joe has an incredibly good psychological framework going on . He 's got a psychologist that 's definitely on board with him , he 's got a group of friends that are on board with him . He 's got NA and AA meetings that he goes to , and we have a medical framework that 's here for him . ''

`` With that combination , I think the likelihood of success is pretty good , but none of us known for sure . ''

Today marks the first day of the rest of Joe 's life . He 's dropping into a new type of circus , possibly as you read this . Today he rolls into the OR for the first of his two surgeries .

`` I 'm fearful ; I 'm scared ; I do n't know what 's going to happen . I 'm jumping into a freezing cold pool , and I do n't know how I 'm gon na react , '' he said days before the surgery .

`` I can tell you what I 'm going to do , how I 'm going to think -- all of it 's untrue , because I wo n't know until I 'm there . When you 're met with pain , only then you 'll know how you 'll react to it . ''

Read more about Joe 's fears leading up to surgery

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Joe Putignano 's career as an acrobat has left him in need of surgery

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Putignano is a recovering addict and fears pain meds after surgery will lead to a relapse

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A four-step pain management plan has been put in place for the contortionist